March 8, 2002
J. Francois Eid, MD, Weill Medical
College of Cornell University and New York Presbyterian Hospital

Viagra has revolutionized the treatment
of erectile dysfunction, but there are promising new drugs on the horizon
that may work even better. Below, urologist and sexual function expert
Dr. Francois Eid, talks about the ups and downs of Viagra, and the drugs
we can expect to see on the market soon.

What are the benefits and the
drawbacks of Viagra?

Of those who have used it, Viagra
improved the erections of about two-thirds of men with erectile dysfunction.
But it's not a perfect drug.

The most common side effects are
headache, flushing of the face, stuffy nose and heartburn. About three
percent of patients develop visual disturbances at 100 mg, the large dose.
And some patients complain of a hypersensitivity to light or a bluish tinge
to light. The side effects for most men are very mild, transient, and they're
very well-tolerated.

Also, Viagra is absolutely contraindicated
in patients who take nitrates. Nitrates is a class of medications that
men who have coronary heart disease -- angina, blocked arteries to the
heart -- need to take in order to help their chest pain.

What about the timing required
to take Viagra?

You need to plan sex with Viagra.
Sex is an activity that we like not to have to plan for. And with Viagra,
you have to plan.

You also can't eat, because anything
that you take that delays gastric emptying will decrease the efficacy of
Viagra. So you can't eat any fatty food, or if you eat meat, it has to
be a very light meal. And then you have to wait about an hour to an hour-and-a-half
before you engage in sexual activity.

Are there any other oral medications
currently available that men can take for erectile dysfunction?

There are two medications that have
actually completed clinical trials, and new drug applications have been
filed with the FDA for each of these medications.

Which means that we may be seeing
them on the market soon?

Yes. On June 28th of 2001, an application
was filed for a drug called "Cialis." And that medication works in a similar
fashion to Viagra, but it has some other properties. It is absorbed slightly
faster, it can be taken with food -- which is a big plus, because sex can
be spontaneous -- and it lasts longer in the bloodstream. The medication
may stay in the bloodstream for about 34 hours. So that's one and a half
days.

Is that a good thing?

Well, it's a good thing and a bad
thing. It's a good thing because let's say you take it on a Friday and
you want to have sex Saturday night, you don't need to take the medication
again. Or you can have sex spontaneously.

However, let's say you get a side
effect from the medication. Then you may experience side effects for longer.

What's the second drug being developed?

Vardenafil, which is also very similar
to Viagra. It is active at lower doses, and targets the chemical that takes
away erections a little more specifically than Viagra. Remember, the way
these medications work is they block the enzyme that takes away an erection.
So getting an erection for men taking these drugs still requires sexual
stimulation and arousal.

But vardenafil may be a cleaner medication;
it isn't associated with the same visual disturbances, for example.

Can these drugs treat all patients
with erectile dysfunction? Is this enough of a choice?

We believe that these drugs will
treat about two-thirds to 80% of men who suffer from erectile dysfunction.
A third of patients who have severe endstage erectile dysfunction, will
not respond to these medications, and these patients will require more
advanced treatment options such as a penile prosthesis or an internal penile
pump.

But these treatments are increasing
awareness of the condition?

Every time there's a new treatment
in the field of erectile dysfunction, more patients come into the treatment
pool. Patients who have tried Viagra once and never wanted to try it again
may want to try one of the new drugs. People who are satisfied with Viagra
will want to come back and try the new drugs to compare. People who were
afraid of Viagra will say, "Gee, you know, now there's a second drug on
the market. Maybe it is safe after all. Let me try it."

Do you have any words of advice
to a patient out there who has erectile dysfunction who maybe hasn't decided
to actually seek treatment yet?

Well, the advice is, number one,
get evaluated. Because really, erectile dysfunction is a sign of an underlying
disorder, which can be more serious, such as high cholesterol levels, diabetes
and so forth.

Number two, you can be successfully
treated in 2002. There isn't a man that we cannot treat. Go to a qualified
urologist and get checked out.